Healthcare Provider Details

I. General information

NPI: 1083091631
Provider Name (Legal Business Name): PROGRESSIVE PHYSICAL THERAPY PLUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12665 GARDEN GROVE BLVD STE 603
GARDEN GROVE CA
92843-1920
US

IV. Provider business mailing address

12665 GARDEN GROVE BLVD STE 603
GARDEN GROVE CA
92843-1920
US

V. Phone/Fax

Practice location:
  • Phone: 714-643-9012
  • Fax: 714-643-9015
Mailing address:
  • Phone: 714-643-9012
  • Fax: 714-643-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY MARSHALL
Title or Position: OWNER
Credential: DPT
Phone: 714-547-1140